Connecticut Health Investigative Teamhttp://c-hit.org
In-depth Journalism on Issues of Health and SafetySat, 17 Nov 2018 12:58:17 +0000en-UShourly1https://wordpress.org/?v=4.9.8Outreach Programs Target Asthma Hot Spots, But More Help Is Neededhttp://c-hit.org/2018/11/14/outreach-programs-target-asthma-hot-spots-but-more-help-is-needed/
http://c-hit.org/2018/11/14/outreach-programs-target-asthma-hot-spots-but-more-help-is-needed/#respondThu, 15 Nov 2018 02:59:11 +0000http://c-hit.org/?p=340723Robert Carmon had a rough start to life. Shortly after birth he developed asthma, a chronic disease that causes inflammation in the lungs and difficulty breathing. His attacks were so severe as an infant that his parents rushed him to the emergency room practically every week. They were terrified he might die.

Today, at age 7, Robert’s asthma has stabilized. With the help of his dad, Chaz Carmon, he inhales a steroid-based medicine each morning and evening, and he carries a rescue inhaler in his backpack in case an asthma attack comes in school or elsewhere.

Steve Hamm Photo.

Robert Carmon, and dad, Chaz demonstrate the inhaler used twice daily to control Robert’s asthma.

Robert is a bright and energetic child, yet he’s not able to play organized sports because of his asthma. “It’s hard on him,” says his father. “I just hope he grows out of it.”

Asthma, one of the most widespread chronic conditions in the United States, afflicts approximately 26.5 million people nationwide, or about 8.3 percent of the population. The cause is not known and there is no medical cure. The disease disproportionally affects people who live in economically disadvantaged urban neighborhoods. In New Haven’s Newhallville and Dixwell neighborhoods combined (the Carmons live in Newhallville), an estimated 17 percent of residents report asthma, more than double the national rate, according to the Community Alliance for Research and Engagement (CARE).

Connecticut’s asthma rate is worse than the nation’s. It’s 11 percent for children and 10.5 percent for adults—and rising. Neighborhoods in Bridgeport, Hartford and New Haven are among the hardest hit. Automobile exhaust, cigarette smoke and mold and vermin in sub-standard housing are among the triggers. “Your ZIP Code matters. It’s a determinant of health,” said Marie-Christine Bournacki, coordinator of the asthma program for the Connecticut Department of Public Health.

In Hartford’s North Meadows neighborhood, for instance, asthma in children from birth to age 4 accounted for 1,738 visits to hospitals per 10,000 residents in 2016, according to DataHaven. In comparison, the rate in Madison, a wealthy coastline town, was just 78. The median household income in Madison is $108,231; while in North Meadows it’s $20,434.

Leaders of government and health care say the key to making progress in working class neighborhoods is to focus more effectively on some of the medical, social and environment factors related to the disease, and to better coordinate society’s responses. Dr. Beverley Sheares, associate professor of pediatrics at Yale School of Medicine, said: “In these settings, asthma is a symptom of what it means to live in poverty so really you have to change the lives of poor people.”

The EmergencyDepartment

When children suffer severe asthma attacks, their parents often take them straight to the emergency department (ED) of the nearest hospital. That’s the right thing to do, say emergency medicine physicians, because it’s difficult for parents to gauge the seriousness of an attack.

At Connecticut Children’s Medical Center in Hartford, emergency physicians treat from 1,500 to 2,000 children per year for moderate to severe asthma. Guidelines for treating asthma in the ED are well established, and the liquid steroid medications they administer stay in the body for up to 72 hours, making it less likely that kids will suffer another attack right away.

In the past year, Connecticut Children’s introduced a new process for treating patients more quickly—by having nurses engage with them soon after they arrive. Previously, it took an average of 75 minutes to treat asthma patients. Now it’s 34 minutes—and the goal is 20. “Kids come in struggling to breathe. To be able to immediately treat them and see a quick turnaround is pretty amazing,” said Eric Hoppa, a pediatric emergency attending physician at Connecticut Children’s.

But emergency physicians say more effective treatment of asthma in the ED is not the long-term solution to the problem. EDs can stabilize people and provide instructions on how to use inhalers and other medications, but they can’t follow them home to monitor their health, to make sure they’re using inhalers correctly, or to spot asthma triggers in the home. That’s why neighborhood clinics and outreach programs are so important.

Economically disadvantaged people typically seek care at community health centers, and Connecticut has a strong network of centers operating in 38 cities and towns. Recently, some of the centers have begun establishing specialized asthma clinics so they can spot the disease earlier, treat it more consistently, and help patients manage it over the long term.

In New Haven, Fair Haven Community Health Care opened its new Respiratory, Airway and Allergy Clinic (RAAC) in June. It’s staffed by a physician who is certified in treating allergy and asthma, an occupational health specialist, a nurse and a care coordinator who investigates the social determinants of each patient’s asthma. The goal is to help them make adjustments in their lives that will reduce triggers. All of the health center’s patients diagnosed with asthma, and those who show signs or symptoms, are referred to the clinic, which is one of a few of its type in greater New Haven.

Asthma can impact children’s lives catastrophically. “If they’re not treated properly, they miss a lot of school; they sit at home and play electronic games and don’t socialize; and they don’t go outside to exercise and get fresh air,” said Dr. Pamela Kwittken, the physician at Fair Haven’s RAAC clinic.

That’s why it’s essential for children in particular to have asthma action plans. These take-home documents describe the treatment the patient requires routinely and what to do if they experience a severe attack. Fair Haven began routinely creating action plans 1½ years ago and now more than 50 percent of the childhood asthma patients have them.

The next step for the Fair Haven clinic is forging a formal partnership with Milford Health Department’s Putting On Airs, part of Connecticut’s home asthma education program, which helps asthmatics and their families follow action plans and reduce the triggers in their homes.

Under Putting On Airs, teams of health workers conduct a series of three home visits with asthma sufferers. The teams typically include a health educator, who makes sure inhalers and other medications are being used properly, and an environmentalist, who looks for dust-mite-infested carpets, moldy bathrooms, mice and cockroaches.

Recently, the regional team at the Stratford Health Department, which runs Putting on Airs for much of Fairfield County, added a third member—a community health worker. Two other health districts elsewhere in the state will follow suit in the coming months.

The community health worker on the Stratford team, Millie Seguinot, helps translate between English and Spanish during home visits, explains the use of inhalers in simple language, and looks for social issues that impact a family’s ability to control the asthma. In addition, she refers families to social service agencies for food and clothing—and helps them make arrangements with their children’s schools.

One Bridgeport family kept canceling appointments with Putting On Airs. Language was an issue. Seguinot visited the mom on her own and learned that she didn’t understand the asthma action plan nor how to administer medications for her daughter on a regular basis. After Seguinot explained things carefully and helped with scheduling, the mom was able to follow the plan and became more comfortable with additional visits from the team. “It’s important to have somebody that these families can relate to. It might be language, culture, ethnicity or even physical appearance,” Seguinot said.

Better Housing

One of the reasons for Connecticut’s high rate of asthma is that much of the urban housing stock is more than a century old, and many urban people live in rentals (72 percent in New Haven). Old buildings tend to harbor asthma triggers, such as mold and dust mites, and landlords are often reluctant to replace carpets where dust mites hang out, or to repair faulty exhaust fans.

It’s not feasible to replace all of the substandard housing, but with advice from the Putting On Airs teams and support from city health departments and doctors, people can pressure their landlords to improve conditions.

Alice Rosenthal, staff attorney for the Center for Children’s Advocacy, recounts a success story in New Haven that provides a blueprint for others. A 12-year-old boy with severe asthma lived with his mom and two siblings in a rundown apartment where grimy old carpets covered the floors. His mom vacuumed the carpets frequently and even paid to have them steam cleaned, but it wasn’t enough. She asked repeatedly for the landlord to remove them. No go.

Finally, after the boy’s primary care doctor, a pulmonologist and Rosenthal wrote letters urging the landlord to take action, he did so. “Now, the boy is not missing school and, because he’s healthier and using less steroids, he can get outside and play sports,” Rosenthal said. Plus, because the mom doesn’t have to be at home all the time, she’s now working—and the family is doing much better economically.

There’s no magic bullet for addressing asthma, or poverty either. For now, government and health care leaders agree, the key is increasing awareness of what can be done to prevent asthma attacks or respond to them. With adjustments in living situations and proper health care, asthma doesn’t have to keep kids—and their parents—living in misery and fear. They can all breathe easier.

Graphic by Marie K. Shanahan

Please note: At the time of the publication of 2016 Community Health Needs Assessments, the DataHaven analysis of hospital encounter data was only available for certain towns and zip codes, while other data are available for towns statewide or by region.

PTSD, a debilitating mental health condition, afflicts between 5 and 23 percent of the 3 million veterans who have served since the 9/11 terrorist attacks. It costs the federal government more than $2 billion just in the first year of PTSD care for veterans, according to a 2012 Congressional Budget Office study.

Melanie Stengel Photo.

Michael Thomas, 49, of Milford served 17 years in the Navy and Navy Reserve, deployed to Afghanistan twice.

But, 17 years into the current conflicts, the link between PTSD and life consequences in this cohort of veterans is still unproven because there haven’t been longitudinal studies on it. Veterans’ advocates say this is a symptom of national indifference to the ongoing wars.

Thomas, 49, a Milford veteran with PTSD and traumatic brain injury, graduated from Yale Law School before he spent 17 years in the Navy and Navy Reserve, working in intelligence. He was deployed twice to Afghanistan, where it was routine to be banged around in Humvees while ducking explosives and to be constantly trying to save others from death and injury. At home, Thomas was angry and “drank like a fish,” he said. His first marriage dissolved.

In his second marriage, with PTSD symptoms including hypervigilance, he slept with a loaded gun under his pillow and had ammunition “all over the place.” One night his wife woke him as he screamed during a nightmare. Lost in his flashback dream, he didn’t recognize her and nearly hurt her. “Really bad things could have happened,” he said.

Thomas, who spent about seven years in cognitive behavioral therapy at the VA, is now pursuing his fifth career since he left the Navy in 2008. He recently started a waste-to-energy company.

Rand Corporation, a nonprofit policy think tank, has done dozens of research reports on veterans for the government and other entities, but hasn’t received a request to pursue the PTSD-life consequences connection in the post 9/11 cohort. “There are not many funders who prioritize that type of work,” said Terri Tanielian, a Rand expert on veterans’ mental health.

Tanielian is an author of a 2008 study on consequences of post-combat mental health. It relied mainly on data from veterans of previous eras and on civilians’ experiences and called for additional research on post 9/11 veterans, which hasn’t happened.

The Henry M. Jackson Foundation for the Advancement of Military Medicine is doing a study of the effectiveness of programs that these veterans access.

A 2017 survey of IAVA members found that mental health and suicide prevention, jobs and reform of the U.S. Department of Veterans Affairs were top concerns. The organization has referred 62 Connecticut veterans to 96 resources for help with employment, finances, education, disability claims, mental health and community involvement.

State Veterans Affairs Commissioner Thomas J. Saadi said he has seen “many veterans go on to rebuild what they’ve lost in their lives once they receive the support services they need.”

Boehm, 34, a Meriden veteran, lost out on a career as a lab technician, a job she held in the Army. She planned to continue that work after discharge, but after being raped twice in the military, she couldn’t mentally separate the Army job from the rapes. After her discharge, she lined up interviews for lab tech jobs, but couldn’t go through with them. “I started having flashbacks, crying,” she said.

After the rapes, Boehm became suicidal, drank excessively, and was angry. She was diagnosed with PTSD. Friends dropped her and family “walked on egg shells” around her, she said.

She plans to graduate from Southern Connecticut State University in May. She said her PTSD deprives her of getting high grades because of related anxiety, depression and problems concentrating. She works as a nanny and co-owns a business that makes mermaid-themed items. She hopes to pursue graduate school.

She receives individual counseling at the Rocky Hill Vet Center and last month started taking new medications.

“I’m in a better head space than I was,” she said.

Jason DeViva, a VA Connecticut Healthcare clinical psychologist, said with “effective treatment, we can remove some of the obstacles that stand in the way of veterans living the kind of life they want to live.”

But access to treatment is still a hurdle for veterans with PTSD, ranging from long waits for VA appointments to distance to receiving private care, said Hannah Sinoway, an IAVA services officer.

Murray, 44, a Bridgeport Army and National Guard veteran, faces other obstacles. He is living in VA transitional housing in Leeds, Massachusetts, after being in prison for two years.

Murray said he was convicted of violating a protective order initiated by his ex-wife and for threatening. He attributed his marital problems to PTSD caused by his exposure to death and ambushes in Afghanistan. He said sometimes he shut down and didn’t talk to his wife for weeks. He had road rage. His wife accused him of hitting her when he was having nightmares.

PTSD “ruined my life,” said Murray, who has an associate’s degree in business management from Sacred Heart University and was active in the Veterans of Foreign Wars. A longtime truck driver, he lost his commercial driver’s license and job after he was arrested.

Thomas Burke, co-founder of High Ground Veterans Advocacy and pastor of Northfield Congregational Church in Weston, said long wars and public indifference can cause veterans with PTSD to feel hopeless.

“Because our nation doesn’t take the end of the war seriously, that graduates to ‘why would my PTSD ever end?’” he said.

]]>http://c-hit.org/2018/11/08/post-9-11-veterans-suffering-from-ptsd-and-nations-indifference/feed/0ER Visits For Children In Crisis Up 20% Over Two Yearshttp://c-hit.org/2018/11/01/er-visits-for-children-in-crisis-up-20-over-two-years/
http://c-hit.org/2018/11/01/er-visits-for-children-in-crisis-up-20-over-two-years/#respondThu, 01 Nov 2018 14:05:26 +0000http://c-hit.org/?p=335485The number of Medicaid-insured children treated in Connecticut emergency rooms for behavioral health crises rose 20 percent between 2014 and 2016, mirroring a national trend – despite efforts to provide non-ER treatments.

Most of the children who go to emergency rooms with behavioral health issues go to one of five hospitals, according to data collected by consultant Beacon Health Options, which manages behavioral health care for the state’s Medicaid population.

The 7-day readmission rate at Connecticut children’s was 9 percent in 2016.

After those 2016 ER visits, the study reported, 10.4 percent of youths were readmitted to the ER within seven days, and 25.6 percent were readmitted within 30 days.

The study’s authors said this indicated that youth and/or family needs were not met or there were issues with families following up with the services offered after discharge.

Hospital emergency departments are often ill-equipped to handle children experiencing behavioral health crises. Those children may benefit more from treatment at community mental health centers, schools or a pediatrician’s office, the report’s authors wrote.

“Emergency departments are not really set up from physical standpoint or from a staffing standpoint to be a primary care behavioral health treatment center,” said Jeff Vanderploeg, the president and CEO of CHDI.

Many of the children did not have a follow-up appointment within a month of their initial trip to the emergency room, the study reported.

The report’s authors reviewed several studies of both nationwide trends and the data from individual hospitals, including one that showed emergency room visits for publicly-insured patients under age 18 experiencing psychiatric problems rose 26 percent from 2001 to 2010.

A 2014 national study cited in the report showed the numbers of psychiatric emergency room visits for children covered by private insurance declined during the same period.

In Connecticut, the 2012 Sandy Hook school shooting prompted state officials to try to reduce behavioral health emergency room visits with initiatives to increase the number of crisis-stabilization beds, create Behavioral Health Assessment Centers and redirect children with autism spectrum disorders to specialized services.

The report’s authors said some of those efforts have been effective, singling out the state’s Mobile Crisis Intervention Service hotline as a “critical alternative” to the ER that parents, guardians and teachers can call to request a clinician who will treat the child at their home or school.

“We have one of the best behavioral health systems for children in the country … and we’re still seeing a large number of children showing up to emergency departments for treatment,” Vanderploeg said.

The report said nearly 1,300 Medicaid-insured children in 2016 were “stuck” in the emergency room after a behavioral health crisis, staying in the hospital for days or weeks before they were discharged, according to the data.

At Yale, the 7-day readmission rate was 10.1 percent.

And about 35 percent of those children did not have a follow-up appointment to see a behavioral or mental health professional in the month after they went to the emergency room. Vanderploeg said that number could indicate poverty, lack of transportation or poor coordination between behavioral health providers are preventing parents and guardians from taking children to mental health appointments.

A CHDI working group that produced the report concluded that the state should try to alleviate pressure on emergency rooms by promoting collaboration between the hospitals, the state’s mobile crisis program and schools, and try to promote follow-up care at community health organizations for children who have been to the emergency room.

“If someone is coming to the ED and the questions are really about how to manage or treat the individual in an ongoing way … the staff are not necessarily trained or focused on addressing those questions,” said Michael Hoge, the director of Yale Behavioral Health at the Yale Department of Psychiatry and a consultant on the working group. “It raised the question of where else they would go,” said Hoge.

Family members of children with behavioral health concerns said they relied on emergency rooms when the child’s behavior was out of control or when the child had suicidal thoughts, often to get a diagnosis or guidance about how to cope, according to the report.

The working group delivered recommendations for state agencies to lessen emergency room visits and improve access to community-based mental health care, including:

• Fund the placement of care coordinators and family support specialists in high-volume emergency rooms.

• Provide telepsychiatry services connecting behavioral health specialists to emergency room staff, a service already available to pediatricians in Connecticut.

• Appropriate funds for the state Department of Children and Families to create Behavioral Health Assessment Centers that would provide evaluation during behavioral health crises, as well as treatment and referral, for children, youth, and families.

Parents can call 2-1-1 to access Connecticut’s Mobile Crisis Intervention Services if their child or adolescent is having a behavioral health crisis that is too much for them to handle on their own. Mobile Crisis responses 24 hours a day, 7 days a week. Services are confidential, and there is no cost to the family.

]]>http://c-hit.org/2018/11/01/er-visits-for-children-in-crisis-up-20-over-two-years/feed/0Midwives Could Be Key To Reversing Maternal Mortality Trendshttp://c-hit.org/2018/10/30/midwives-could-be-key-to-reversing-maternal-mortality-trends/
http://c-hit.org/2018/10/30/midwives-could-be-key-to-reversing-maternal-mortality-trends/#respondWed, 31 Oct 2018 02:07:19 +0000http://c-hit.org/?p=334338The Connecticut Childbirth & Women’s Center in Danbury is a 50-minute drive from Evelyn DeGraf’s home in Westchester. Pregnant with her second child, the 37-year-old didn’t hesitate to make the drive—she wanted her birth to be attended by a midwife, not a doctor.

DeGraf believed midwifery care to be more personal and less rushed than that delivered by obstetrics/gynecologists (OB/GYNs). She also knew an OB/GYN would deem her relatively advanced maternal age and previous cesarean section history too high-risk to attempt a VBAC, or vaginal birth after cesarean section.

But she had to drive roughly 35 miles to find a midwife because there aren’t many of them.

Despite the fact that an estimated 85 percent of women are appropriate for midwife care, midwives attend about 11 percent of births in Connecticut, said Holly Kennedy, professor of midwifery at Yale School of Nursing. By contrast, about half of all babies in England are delivered by midwives, according to National Health Services statistics. Kennedy sees a direct correlation between lower use of midwives and higher maternal mortality.

“If you scaled up midwives, you would avert over 80 percent of maternal deaths,” Kennedy said. In Connecticut, there are 211 licensed nurse-midwives, compared to 945 licensed OB/GYNs, according to state Department of Health records. Unlike some other states, which employ midwives who do not require nursing degrees, Connecticut recognizes only nurse-midwives, who hold advanced degrees in nursing and additional training in midwifery.

Babies born to black women are more than twice as likely to die in the first year of life than babies born to white women, and black women are 243 percent more likely than white women to die from pregnancy-related complications, according to the Centers for Disease Control and Prevention.

DeGraf’s second child was born vaginally at Danbury Hospital, assisted by a nurse-midwife employed by the Connecticut Childbirth Center. Her low-intervention delivery is common of births attended by midwives who, statistically, use fewer intervention than physicians during labor and delivery.

Cesarean sections, considered major surgery, carry well-established risks: higher rates of hemorrhage, transfusions, infections, and blood clots—all primary causes of maternal mortality, whose rates increased nationwide (with the exception of California) by 26.6 percent between 2010 and 2014, according to a study supported by The National Center for Biotechnology Information.

Melanie Stengel photo

Caroline Dicolla of Ridgefield, at left, gets some help bundling up her infant daughter, Kohana Domejczyk, from midwife Cathy Parisi after Dicolla’s appointment the Connecticut Childbirth & Women’s Center in Danbury.

Midwives are also linked to higher rates of physiologic birth and fewer adverse neonatal outcomes, according to a nationwide 2018 study, which ranked states by how well midwives are integrated into regional health care systems. Connecticut fell into the bottom third. Experts say the low ranking is due in large part to a lack of access to midwives. Many would-be nurse-midwives never get the chance to train for the position in Connecticut.

“At Yale, I get at least 100 applicants for our [nurse-midwife] program. Most are highly qualified, but I can only accept 25 percent,” said Kennedy, an author of the 2018 study. She explained that most federal health education dollars are directed to schools of medicine, thereby limiting resources for midwifery education, including the ability to reimburse preceptors who oversee clinical training of nurse-midwife students.

Those who do find spots in one of Connecticut’s two nurse-midwife programs (Fairfield University offers a doctor of nursing practice in midwifery) may confront challenges to practicing upon graduation. Many face high debt hurdles, Kennedy says, and search the country for employers willing to repay their student loans. Those who do find jobs in Connecticut may be stymied from practicing to the fullest extent possible.

Cathy Parisi is director at the Connecticut Childbirth & Women’s Center, the state’s only freestanding birth center. She says that while Connecticut legislation authorizes its nurse-midwives to practice to “full scope care,” which includes admitting privileges at hospitals that credential nurse-midwives, not all hospital bylaws reflect current state statutes; therefore, some hospitals in Connecticut do not grant admitting privileges.

“Little things like that are terribly irritating,” said Parisi, who suggested several possible reasons why hospitals wouldn’t allow a nurse-midwife to practice within the full scope of her license, including pressure from physicians, medical staff or the hospital legal department or, simply, resistance to change.

Nurse-midwives follow the same standards of care as OB/GYNs, but the difference in how they deliver care has an increasing number of women gravitating to the midwifery model. The Connecticut Childbirth & Women’s Center, which at its inception about 25 years ago delivered five or six births per month, now facilitates up to 35 per month and has increased its staff accordingly, from two to five full-time nurse-midwives.

Melanie Stengel photo

Midwife Lindsay Lachant lets some light into the birthing room at the Connecticut Women’s & Childbirth Center in Danbury.

One of its patients is 25-year-old Teja Brindisi, a resident of Naugatuck, who switched her healthcare provider halfway through her first of two pregnancies from an OB/GYN practice to the Connecticut Childbirth & Women’s Center. For her second child’s delivery, she had a natural water birth delivery at the center with the aid of a nurse-midwife, an experience she called “amazing.”

It was also affordable, covered by her health insurance to the same extent a hospital birth attended by an OB/GYN would have been. With rare exceptions, all insurances cover midwifery services, including HUSKY/Medicaid, though some plans reimburse midwifery services at 90 percent of the physician rate, said Stephanie Welsh, vice president of the American College of Nurse-Midwives’ Connecticut affiliate.

“We have been fighting the battle for equal reimbursement for many years, and will continue to do so,” Welsh said.

While the cost to patients is typically the same whether they use a nurse-midwife or an OB/GYN, they may feel like they’re getting a better deal with a nurse-midwife.

“By seeing only two to three patients an hour a midwife has time to spend with her client. Physicians simply do not have the time in their schedules to accommodate such lengthy visits for a low-risk woman,” Parisi said. In contrast, their midwife practice schedules only two to three patients per hour.

Physicians may spend less time with patients, but tend to apply medical interventions more readily than nurse-midwives, whose model relies less on medical interventions and more on educating and communicating with patients.

“Midwifery is a relationship-based profession. One of the reasons we probably do have better outcomes is because we listen to women,” Yale’s Kennedy said.

Despite differing perspectives, many midwives and OB/GYNs work together and report a collegial relationship.

“The physicians in my practice are very receptive to midwifery input, and really value our expertise,” said ACNM’s Welsh, who practices at Manchester Hospital with six other midwives and 14 physicians.

John Kaczmarek, an OB/GYN with privileges at St. Mary’s Hospital and Waterbury Hospital, said of nurse-midwives: “I’ve learned a lot from them; for example, we don’t always have to force nature.”

But Kaczmarek was quick to acknowledge the hierarchy within his practice. “[Nurse-midwives] practice independently but know their limitations,” he said.

“They know when to call for physician help.”

That may be true, but when it comes to compassionate care, midwives seem to know no limits. “With the midwives, I felt more taken care of,” Westchester’s DeGraf said.

No amount of fame or fortune can run interference when it comes to mothers dying or at-risk during pregnancy, childbirth, or early motherhood. And that holds especially true for African American women.

The World Health Organization defines maternal mortality as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy” not from accidental or incidental causes. Worldwide, 99 percent of women who die during or after childbirth live in developing countries. Skilled care before, during, and after pregnancy are a proven deterrent.

In Connecticut, between 2011 and 2014, the official count for pregnancy-related deaths is 8. There are no more recent numbers, and that number is inaccurate. Maternal deaths have been woefully underreported, with scant attention paid to racial breakdowns. Connecticut was, however, included in a 2017 study that looked at 27 states and the District of Columbia. The report said that between 2013-2014, there were just over 56 maternal deaths for every 100,000 births among African American mothers, compared to just over 20 for white mothers.

iStock Photo.

In CT, the official count of pregnancy related deaths is 8 from 2011-2014. There are no more recent numbers.

Maternal deaths are tied to multiple factors, including poverty, access to health care, the health of the mother prior to pregnancy, as well as less easily-identified reasons. A recent California survey said doctors tend not to listen to African American women as carefully as they do white women. When her daughter Alexis Olympia was born last September by emergency C-section, tennis great Serena Williams had to ask twice for a CT scan. (A nurse thought the tennis great was loopy from pain medicine.) When her medical team finally listened to Williams’ suggestion, the scan revealed blood clots in her lungs. Later, her C-section burst open, and the complications nearly grounded her.

The crisis has been building, but only recently have elected officials started to take notice. Earlier this month, a bipartisan group of U.S. Senators asked the White House to commit to reducing maternal mortality. The group includes 14 senators, including Lisa Murkowski (R-Alaska); Cory Booker (D-New Jersey); and both senators from Florida, Bill Nelson, a Democrat, and Marco Rubio, a Republican. The senators asked for more data, particularly around women living in poverty who receive government aid.

Also earlier this month, after a USA Today investigation into the phenomenon, the powerful House Ways and Means Committee sent letters 15 hospitals chains, asking them for information about the deaths of new mothers in their care, as well as how they identify at-risk women, the number of deliveries they performed in 2017, and information about pregnancy-related deaths of women in their care. The hospital chains operate 900 hospitals around the country.

Add to that some private initiatives, including a grant program from Merck & Co., a pharmaceutical company that announced plans to give $500 million to city-based organizations that work to reduce maternal mortality.

Unfortunately, this program isn’t state-funded, either. In the face of this health crisis, an unfunded program feels like lip service. The next session starts in January. Let’s see if Connecticut’s legislators can take another, serious look at this. Research takes funding. Collecting data does, as well.

Susan Campbell is a distinguished lecturer at the University of New Haven. She can be reached at slcampbell417@gmail.com.

]]>http://c-hit.org/2018/10/23/u-s-maternal-mortality-rate-is-disgraceful-worse-for-women-of-color/feed/0Health Insurance Open Enrollment Begins Nov. 1; You Can Window Shop Starting Todayhttp://c-hit.org/2018/10/22/health-insurance-open-enrollment-begins-nov-1-you-can-window-shop-starting-today/
http://c-hit.org/2018/10/22/health-insurance-open-enrollment-begins-nov-1-you-can-window-shop-starting-today/#respondMon, 22 Oct 2018 12:52:09 +0000http://c-hit.org/?p=330722Consumers will have the shortest open enrollment period yet to shop for 2019 health insurance plans – 45 days — but they can “window shop” and compare plans beginning today.

Open enrollment for health plans effective Jan. 1, 2019, will run from Nov. 1 to Dec. 15, giving consumers the least amount of time to enroll in or renew plans since the Affordable Care Act (ACA) became law. Last year, consumers had an additional week.

As a result, Access Health CT (AHCT), Connecticut’s health insurance exchange, is broadening its outreach and marketing efforts and, for the first time, giving consumers a sneak peek at plans.

“A lot of people want to see what options they have ahead of open enrollment,” said AHCT Marketing Director Andrea Ravitz. “Every year, we need to remind individuals that they have choices. We want to make sure they have access to as much information as possible to pick the right plan.”

This year’s marketplace offers plans from ConnectiCare and Anthem. Open enrollment is Nov. 1-Dec. 15.

Consumers can browse plans starting today using a special tool at accesshealthct.com. In addition, AHCT is holding a series of events across the state and offering phone, online and in-person assistance to help individuals choose a plan.

The average ACA monthly premium cost was $689 this year, but for 75 percent of enrollees the average subsidy was $600, according to a report from the Centers for Medicare & Medicaid Services.

The marketplace has two insurance carriers, ConnectiCare and Anthem. Many plans offered for 2019 under both carriers will cost more, but in September state regulators drastically reduced the rate hikes both carriers had sought.

Anthem had proposed a 9.1 percent rate increase for 2019 plans, but regulators approved an average premium increase of 2.7 percent. ConnectiCare had sought a 13 percent increase, which was pared down to an average increase of 4 percent.

As in the past, plans are organized into bronze, silver, gold and platinum categories, and consumers should compare plans to see what works best for them. Platinum plans, for instance, typically have higher premiums but lower out-of-pocket costs, whereas bronze plans have the lowest premiums but highest out-of-pocket costs.

No ‘Opt Out’ Fines

One big change consumers will notice for 2019: There will be no financial penalty for opting not to buy insurance.

In previous years, most consumers had to have insurance or face a fine. Those who had no insurance in 2018 will pay either 2.5 percent of their yearly household income or $695 per person ($347.50 per child), whichever is higher, when they file their 2018 tax returns in early 2019.

Ravitz said AHCT conducted focused groups with about 60 individuals to gauge whether the absence of a penalty would impact enrollment trends for 2019.

“The majority said, with or without the tax penalty, it wouldn’t affect their decision,” she said.

The Marketplace

AHCT is the online marketplace created by the ACA, sweeping health care reform legislation that requires most Americans to have health insurance.

During open enrollment, people without coverage can shop for insurance plans and those with coverage can renew or change their plans.

Ravitz said it is too soon to predict how many people will enroll in plans through the exchange this year, but 114,134 did last year, up more than 2 percent from the previous year. Of those, most—about 73 percent—enrolled in plans offered by ConnectiCare.

Various improvements have been made to AHCT’s website, including enhanced live chat capabilities and a new “Compare Plans” link that will let consumers see various plans’ physician networks, prescription coverage, out-of-pocket expenses and other benefits, Ravitz said.

“This is going to allow people to make better, more informed choices,” she said of the comparison tool. While monthly premium costs often play major roles in which plans consumers choose, she added, “We want to make sure people are able to make better decisions rather than just looking at the price tag.”

After open enrollment ends on Dec. 15, consumers can sign up for 2019 coverage only if they have a qualifying life event, such as loss of insurance, marriage or the birth of a child. New this year, pregnancy is now a qualifying life event.

Consumers can apply online, call AHCT at 855-805-4325, get in-person help, or use AHCT’s free mobile app for smartphones or tablets.

While most people have to wait until Nov.1 to enroll in plans, enrollment in Medicaid HUSKY and the Children’s Health Insurance Plan (CHIP) is open year-round to eligible people and families.

AHCT, now in its sixth year, also will open seven enrollment centers statewide in early November where people can receive in-person help, and will host six enrollment fairs. In addition, it will host a traveling series of educational discussions called “Healthy Chats,” during which experts will speak to groups of people about enrollment options as well as answer questions.

Usually, some people—about 15 percent of those who enroll in plans through AHCT—have trouble verifying the income or citizenship information they must submit once the open enrollment period ends, Ravitz said. AHCT is increasing efforts to reach and help those people too, she added.

]]>http://c-hit.org/2018/10/22/health-insurance-open-enrollment-begins-nov-1-you-can-window-shop-starting-today/feed/0State Disciplines LPN For Mistreatment Of York Inmate, Disciplines 7 Othershttp://c-hit.org/2018/10/19/state-disciplines-lpn-for-mistreatment-of-york-inmate-disciplines-7-others/
http://c-hit.org/2018/10/19/state-disciplines-lpn-for-mistreatment-of-york-inmate-disciplines-7-others/#respondFri, 19 Oct 2018 12:35:23 +0000http://c-hit.org/?p=329116The state Board of Examiners for Nursing this week disciplined eight nurses, including reprimanding a York Correctional Institution nurse for failing to properly care for an inmate who suffered a serious brain injury in the prison medical unit in 2014.

Licensed practical nurse Shanequa Moore of New Haven also had her license placed on probation for two years after the board found that Moore failed to practice nursing with empathy, compassion and care in the inmate’s case, a consent order she agreed to said. While not admitting any wrongdoing, Moore chose not to contest the allegations. She has completed courses in medical documentation, ethics, professional accountability, mindfulness and empathy, the order said.

Moore is the second nurse disciplined by the board in connection with the injury at the Niantic prison. In April, it reprimanded registered nurse Mary Howe of Griswold, the former head nurse at the prison, and placed her license on probation for three years.

A consent order Howe agreed to said she failed to intervene when the inmate complained of chest pain and a head injury.

The former inmate, Amy Rolon, then 36, was being held before trial on misdemeanor charges of sixth-degree larceny and failure to appear in court. She suffered a traumatic brain injury at York and filed a $7.5 million medical-neglect claim against the state Department of Correction in 2016. The charges were later dismissed and she has since been treated in a long-term care facility. A conservator for Rolon settled the case for $780,000 in 2017, court records show.

On Wednesday, the board reprimanded two nurses and placed their licenses on probation for a year in connection with a patient who died after they failed to follow the patient’s advanced directive, records show.

RN Ana Alvarez of New Britain was disciplined in connection with the 2017 incident in which a patient died at The Reservoir, a nursing home in West Hartford. A consent order she agreed to said that Alvarez failed to initiate CPR or send the patient to a hospital, in violation of the patient’s directive.

LPN Marcia Guerry of Avon received the same punishment for failing to properly perform or continue CPR on the same patient, a consent order she agreed to said. Both nurses chose not to contest the allegations and were ordered to take courses in advanced directives, the orders said.

The board suspended the licenses of two nurses after finding that their continued practice as a nurse posed a threat to public safety.

One of them, RN Heather Breen of Wallingford, tested positive for an amphetamine in February, March and May and falsified a medical record, state records show. In 2015, Breen had stolen morphine, oxycodone and hydrophone while working at Bridgeport Hospital and abused the drugs to excess, records show.

The second nurse, Kathryn Y. Ford, an RN from Wilton, was accused of using marijuana, cocaine and heroin to excess from January 2017 to August of this year, state records show.

The board reinstated the license of RN Renee Devoe, whose hometown was not listed, and placed it on probation while she takes a refresher course. Once she completes the course and passes a licensing exam, her license will be placed on probation for one year, during which she must pass random drug tests, the board’s memorandum of decision states.

Devoe’s license was revoked in 2009 based on evidence that her abuse of heroin was affecting her ability to practice safely, the memo said. After a hearing in June showed that Devoe has had a lengthy period of being drug-free, the board concluded she was safe to practice again, the memo said.

The board also agreed to reinstate the LPN license of Kokumo Lauray of East Hartford and place her license on probation for one year once she passes an LPN refresher course and a licensing exam. In 2010, the board had revoked her license based on evidence that in 2009, she had lied about not having a felony conviction when she applied to have her nursing license renewed, state records show.

State records show that between 2000 and 2008, Lauray had been convicted of seven criminal charges, including a felony robbery charge in Bloomfield in 2008. After holding a hearing in May of this year, the board concluded there was sufficient evidence that she is now safe to practice as an LPN again, its memorandum of decision states.

The board continued the suspension of the RN license of Brian Gross of Feeding Hills, Massachusetts through Oct. 31 and then will place it on probation for four years. His license was suspended in February after he failed to undergo random alcohol tests from November to January under a previous four-year probation, state records show. The previous probation was imposed because of his abuse of alcohol, but after a hearing in April, the board concluded he was safe to return to practice as a nurse as of Nov. 1, its memorandum of decision states.

The board dropped all charges against a Stamford Hospital nurse who had been accused of stealing Dilaudid meant for 21 patients because the RN, Kerrisha Stacy-Ann Hurd of Elmont, New York, has voluntarily surrendered her nursing license, records show.

]]>http://c-hit.org/2018/10/19/state-disciplines-lpn-for-mistreatment-of-york-inmate-disciplines-7-others/feed/0State Places Yale Doctor On Probation For Alcohol Abusehttp://c-hit.org/2018/10/16/state-places-yale-doctor-on-probation-for-alcohol-abuse/
http://c-hit.org/2018/10/16/state-places-yale-doctor-on-probation-for-alcohol-abuse/#respondTue, 16 Oct 2018 19:36:55 +0000http://c-hit.org/?p=327928The state Medical Examining Board Tuesday placed a Yale Cancer Center doctor’s license on probation for five years, saying his excessive abuse of alcohol affects his ability to practice as a physician.

The board accepted a consent order that said Dr. Harris E. Foster Jr. abused alcohol to excess at various times between 2012 and May of this year. Last week, the cancer center’s website listed Foster as a professor of urology at the Yale School of Medicine and as the director of female urology and neuro-urology at the center in New Haven. After a reporter inquired about his status, the cancer center’s website on Tuesday only listed him as a urology professor.

Mark D’Antonio, a spokesman for Yale New Haven Hospital, said Tuesday that Foster is still affiliated with the cancer center, but he cannot comment further because Yale does not comment on personnel matters.

In signing the consent order, Foster admitted no guilt or wrongdoing but chose not to contest the matter. During the probation, Foster must attend therapy and support group sessions and pass random drug and alcohol tests, the order said. He is also barred from conducting medicine in a solo practice for five years.

The board also approved two cease and desist orders for two women that the state Department of Public Health (DPH) said have been practicing medicine without a license.

In the first case, Zaadia Arzu of Stratford agreed to a consent order that said from November 2017 to March, she administered vaccinations, inserted intravenous catheters and administered medication to one or more patients without a medical license. She also used the initials “M.D.” on her business card and a business sign during the same time period, the consent order.

Under the order, Arzu agreed to stop practicing medicine without a license. DPH received a complaint about Arzu in March from a former patient of a medical practice in Stratford, records show.

The board also ordered Lauren Stone of Wilton to stop practicing homeopathy without a license. That branch of medicine embraces a holistic, natural approach to the treatment of the sick.

DPH began an investigation of Stone’s practice in 2016 based on an anonymous complaint. A consent order she agreed to said she treated six patients for a variety of ailments, including joint pain, liver dysfunction, autism, Lyme disease, infections, liver and kidney inflammation, anxiety and “stabbing stomach pain” with plant extracts as antimicrobials, non-prescription substances and colloidal silver. The FDA has taken action against some manufacturers of colloidal silver products for making unproven health claims.

While admitting none of the allegations, Stone chose not to contest the matter and agreed to stop practicing medicine without a license, the consent order said.

Mariella LaRosa, Stone’s Waterbury attorney, said that Stone has a master’s degree in nutrition sciences and believed she was practicing appropriately in that field while her patients continued to be under the care of physicians.

But board member Dr. Daniel Rissi said, “She was making diagnoses and that clearly is the practice of medicine.”

The board also dropped the charges against a Weston psychiatrist who had been accused of letting his secretary sign prescriptions for controlled substances for herself and for patients he had not examined. The action came because Dr. Harry Brown has voluntarily surrendered his medical license, DPH Staff Attorney David Tilles said.

In August, the board rejected a consent order that would have imposed a $25,000 fine against Brown, with some members saying the proposed penalty was too lenient. It would have been the fourth time that Brown had been disciplined by the state board.

]]>http://c-hit.org/2018/10/16/state-places-yale-doctor-on-probation-for-alcohol-abuse/feed/0Medicare To Penalize 27 Hospitals For High Readmissionshttp://c-hit.org/2018/10/08/medicare-to-penalize-27-hospitals-for-high-readmissions/
http://c-hit.org/2018/10/08/medicare-to-penalize-27-hospitals-for-high-readmissions/#respondMon, 08 Oct 2018 12:33:33 +0000http://c-hit.org/?p=324849Most Connecticut hospitals will lose a portion of their Medicare reimbursement payments over the next year as penalties for having high rates of patients being readmitted, new data from the Centers for Medicare & Medicaid Services (CMS) show.

Statewide, 27 of the 29 hospitals evaluated—or 93 percent—will be penalized in the 2019 fiscal year that began Oct. 1, according to a Kaiser Health News analysis of CMS data.

Waterbury Rep-Am Photo.

Waterbury Hospital received the largest penalty, 2.19 percent.

The Medicare program has penalized hospitals since the 2013 fiscal year for having high rates of patients who are readmitted within a month of being discharged. Nationally, hospitals will lose $566 million in penalties, which were instituted as part of the Affordable Care Act to encourage better health care delivery.

Two facilities, Hebrew Home and Hospital Inc. in West Hartford and Stamford Hospital, were evaluated and received no penalty. Last year, Stamford was penalized 0.2 percent and Hebrew Home and Hospital had no penalty.

Two acute care facilities, The Connecticut Hospice Inc. in Branford and Connecticut Children’s Medical Center in Hartford, aren’t evaluated under the program.

In the years since penalties were introduced, hospitals have taken various steps to reduce readmissions, said Dr. Mary Cooper, chief quality officer and senior vice president for clinical affairs at the Connecticut Hospital Association.

Hospital staffs throughout the state are more attentive now to social determinants that impact people’s health—things like housing, transportation, food insecurity and the ability to understand discharge instructions. Increasingly, hospitals are working with community groups to connect patients with resources they need once they leave the hospital, Cooper said.

“It certainly has had an impact on behavior in hospitals. It’s drawn the attention to what happens after the hospitalization, things that hospitals had said [previously] they were not in control of,” she said.

Still, Connecticut had a relatively high share of its hospitals penalized, compared with other states, data show. Just seven states had more than 93 percent of evaluated hospitals punished.

While fines have motivated hospitals to take more creative approaches to their work, more needs to be done, said Lisa Freeman, executive director of the Connecticut Center for Patient Safety.

“It’s bigger than just a hospital problem,” she said, alluding to the broader health care system. “We’re treating sickness, we’re not providing health. That’s the problem with not appreciating that a patient’s health and their well-being is dependent on so much more than medication.”

CMS penalized Bridgeport Hospital 2.01 percent.

Continued efforts to seek new approaches and re-examine how care is provided would help reduce readmissions, Freeman said.

The penalties imposed for the 2019 fiscal year reflect a major change in CMS’ methodology. For the first time, hospitals were placed into “peer groups” and their readmission rates were compared against facilities that serve similar proportions of low-income patients. CMS then examined readmission rates among the various peer groups from July 2014 through June 2017 to determine whether penalties were warranted.

Prior to the change, officials at some “safety net hospitals,” which treat a large share of Medicaid- or Medicare-eligible patients, argued that readmissions sometimes happen through no direct fault of the hospitals. Low-income patients are less likely to have a primary physician or seek follow-up care, for instance.

“Safety net hospitals are going to have greater challenges in terms of readmissions and other things,” Freeman said. “To penalize hospitals just because that is their primary customer is not reasonable. On the other hand, it is reasonable to expect that care can be provided at a better level so these people can lead healthier lives.”

She added, “Everybody’s entitled to receive the best care we can give. We have to keep trying to make it better.”

Addressing the myriad social factors that impact health is the biggest challenge facing hospitals, Cooper said, but the work they are doing with community-based organizations is a good start. Many hospitals are working with consultants to better understand and address social barriers to care, she added.

“It’s always a partnership among multiple groups,” she said. “Patients are having a voice and organizations are being respectful of that patient voice. The hospitals are asking to be partners with the patients. That’s a big change in culture. That’s really going to have a tremendous impact.”

]]>http://c-hit.org/2018/10/08/medicare-to-penalize-27-hospitals-for-high-readmissions/feed/0Consumers Feel Sticker Shock As Out-Of-Pocket Health Care Costs Risehttp://c-hit.org/2018/10/01/consumers-feel-sticker-shock-as-out-of-pocket-health-care-costs-rise/
http://c-hit.org/2018/10/01/consumers-feel-sticker-shock-as-out-of-pocket-health-care-costs-rise/#respondMon, 01 Oct 2018 15:32:59 +0000http://c-hit.org/?p=322065In February, Joan Goldstein of Monroe received a panicked call for help from her wife, Lauren Goldstein. Joan found Lauren rolled up like a ball on the floor in her office bathroom. “I have never seen her sick in 15 years,” Joan said.

When Lauren couldn’t stop vomiting, Joan took her to the emergency room at St. Vincent’s Medical Center in Bridgeport, where she received fluids intravenously—“three bags,” Joan said.

But the couple’s insurance company declined to cover the bill for $3,094 “because it wasn’t a medical emergency,” said Joan, who is still contesting the decision. Just less than a year ago, the Goldsteins had switched insurers because of a premium hike.

Lauren Goldstein (left) and her wife, Joan Goldstein, are fighting their insurance company’s refusal to pay a $3,094 ER bill.

In interviews consumers said they are delaying medical procedures, withdrawing money from retirement savings to pay bills, cutting back on big-item purchases, and even putting off planned vacations.

Data from 2007 through 2017 from the National Center for Health Statistics show enrollment in high-deductible health plans without Health Savings Account (HSA) among adults with employment-based coverage rose from 10.6 percent in 2007 to 24.5 percent in 2017 nationally. Enrollment in plans with HSA climbed 4.2 percent to 18.9 percent for the period.

According to the Kaiser Family Foundation, 50 percent of workers have health insurance with a deductible of at least $1,000, compared with 22 percent in 2009.

“We’ve certainly seen an increased trend toward higher deductible health plans as a way to control increasing [business] costs,” said Ken Comeau, president of the state trade association CBIA Service Corporation in Hartford.

State regulators, responding to how consumers have changed the way they manage their health and their finances, recently denied proposed rate increases.

In September, Katharine Wade, insurance commissioner, reduced the average rate increases proposed by ConnectiCare Benefits Inc. and Anthem Inc. from 12.3 percent to 2.72 percent for plans that will be sold via the state’s health insurance exchange in 2019. In August Sen. Richard Blumenthal wrote to Wade: “Any rate increase—no matter how small—can and will impact Connecticut families’ bottom line.”

“In the past people were looking at just premiums. Now they have to look at deductibles and co-pays,” said Gerald O’Sullivan, director of Consumer Affairs at the Connecticut Insurance Department, which received 37 complaints related to ER visits for the first three quarters of 2018, compared with 34 in all of 2017.

Of those complaints, 11 consumers questioned their cost shares and five complained about being denied coverage. One consumer received a “surprise bill” for an ER doctor who was not in the network covered by their insurance policy.

Overall, the Consumer Affairs division addressed 5,800 complaints and inquiries last year and helped policyholders recoup nearly $4.8 million in 2017.

While many fear losing their health care coverage, unexpected medical bills top the list of concerns in a recent Kaiser poll. Nationwide, 4 in 10 insured adults aged 18-64 said they had been blindsided with such a bill in the past year. Overall, 89 percent of Americans said they were concerned by an increase in out-of-pocket costs. A majority 71 percent of the public said hospitals charge “too much” and 70 percent said insurance companies make “too much money.”

Lara Herscovitch of Guilford, the former state troubadour, worries about the what-ifs. Her transition from a full-time employee working for nonprofits, to a full-time freelance musician has been “joyful, with one glaring exception—my out-of-pocket health care costs increased by more than 600 percent,” she said.

Carl Jordan Castro Photo.

Lara Herscovitch holds a list of medical out-of-pocket-expenses that total over $6,000.

Herscovitch expects to end the year with $6,359 in out-of-pocket health expenses, including monthly premium payments for insurance, if there are no additional medical needs. She said she’s only been to the doctor once this year for her annual checkup. When she thought she might have contracted Lyme disease this summer, she chose not to go to her physician, waiting instead for symptoms to manifest.

“Health care costs are eating into my personal and business costs,” Herscovitch said. “I’m able to make it work right now because I’m healthy. If I got sick, it would be very different. I love Connecticut and don’t want to leave, but all my musician friends rave about affordable health care in Massachusetts, which has me wondering if I should move,” Herscovitch said.

In 2016 the per-capita out-of-pocket health care expenditure averaged $1,093 nationally. “That’s not an insignificant sum,” said Steven Lanza, professor of economics at the University of Connecticut. In comparison, up to 57 percent of Americans reported savings of less than $1,000, according to a 2017 GoBankingRates survey. The takeaway? Average Joe and Average Jane cannot afford to be sick.

Take, for example, Erin Nowak of Manchester, who went for a blood test and physical checkup earlier this year and received a bill of $681, which she had to pay out-of-pocket. “It’s the first time in my life I’ve paid for routine bloodwork,” said Nowak, who at first thought Manchester Hospital had sent her the wrong bill. Mother to a toddler with a congenital heart disease, Nowak said she paid $120 out-of-pocket for each visit to her therapist for post-partum depression until the deductible of $5,000 with her private insurer was met. She cut back on dining out and vacations to pay the bill. “Do we mothers get proper mental care after child birth?” she asked. “It’s a huge issue.”

Others, like Jake Tedford of Tolland have incurred debt despite having private insurance through his employer. Tedford in June took a loan of $5,800 at a 5 percent interest rate against his 401(k) to pay off two previous ER visits for migraine, he said, as well as a shoulder surgery in March at Rockville General Hospital.

Unexpected fees add yet another layer of costs already beleaguered consumers have to pay. Deborah Bax, 69, of Waterford has $53 debited monthly from her bank account to pay off a services fee of $948.75 charged by Lawrence + Memorial Hospital for an ER visit in June of last year. Bax, who experienced flashes of light in her eye, thought she might have a detached retina. But it turned out to be what’s called floaters or microscopic fibers.

Bax had already shelled out a co-pay of $280 for her ER visit that included ophthalmology, an ER physician, radiology diagnostics and miscellaneous medical services, according to a copy of the bill obtained by C-HIT. She was shocked, she said, when she received another bill toward fee for services.

In fact, according to new data from the Office of Health Strategy, hospitals levied an estimated $1.2 billion in outpatient facility fees between 2015 and 2017.

“I paid for the ER visit,” Bax said. “That second bill? It’s just not fair.”